高胰岛素-正葡萄糖钳夹实验评价Roux-en-Y胃旁路术对2型糖尿病患者胰岛素抵抗的改善作用

Effect of laparoscopic Roux-en-Y gastric bypass on improvement of insulin resistance in Type 2 diabetic patients evaluated by hyperinsulinemic-euglycemic clamp

目的:随着人们生活水平的提高,2型糖尿病患者逐年增加,疾病给社会和患者带来了极大的经济和生活负担。目前已证实减重手术(Roux-en-Y胃旁路手术)能改善糖尿病患者的代谢指标从而使患者获益,但具体机制仍在研究中。本研究旨在运用高胰岛素-正葡萄糖钳夹实验评估腹腔镜Roux-en-Y胃旁路术对改善2型糖尿病患者胰岛素抵抗的作用。方法:通过高胰岛素-正葡萄糖钳夹实验分析40例行腹腔镜Roux-en-Y胃旁路术患者术前及术后6个月的外周葡萄糖利用率(M值),同时比较术后6个月和术前空腹血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇水平及体重指数等指标的变化。结果:腹腔镜Roux-en-Y胃旁路术后患者的外周葡萄糖利用率较术前明显升高,空腹血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇水平及体重指数等指标较术前下降(均P<0.05)。结论:腹腔镜Roux-en-Y胃旁路术显著改善2型糖尿病患者的胰岛素抵抗,降低血糖、血脂等指标,对2型糖尿病的治疗效果肯定。

Objective:With the increase of people’s living standards increasing year by year,Type 2 diabetes has brought great economic and living burden to the society and patients.Bariatric surgery can improve metabolic indicators in patients with diabetes,but specific mechanisms are still under study.This study aims to evaluate the effect of Roux-en-Y gastric bypass(RYGB)on insulin resistance in patients with Type 2 diabetes by hyperinsulinemic-euglycemic clamp.Methods:The peripheral glucose uptake(M value)of 40 patients undergoing laparoscopic Roux-en-Y gastric bypass surgery before and 6 months after the operation were analyzed hyperinsulinemic euglycemic clamp.Fasting blood glucose,glycosylated hemoglobin,triglycerides,andlow-density lipoprotein cholesterol levels as well as body mass index were also analyzed.Results:M value of patients after laparoscopic Roux-en-Y gastric bypass was significantly higher than that before the operation,while indexes such as fasting blood glucose,glycosylated hemoglobin,triglycerides,and low-density lipoprotein cholesterol levels as well as body mass index were lower than those before the operation(all P<0.05).Conclusion:Laparoscopic Roux-en-Y gastric bypass surgery significantly improves insulin resistance in patients with Type 2 diabetes,decreases blood sugar and blood lipid,and can exert a positive effect on the treatment of Type 2 diabetes.